Hospital Train

Here is a painting, by the British artist, Evelyn Dunbar, of a WW2 hospital train. I remember this painting from when I was very small, (it was illustrated in one of our books at home). I think I was fascinated by the idea of a train with beds…which I was familiar with from France; and I was impressed by the terrible stillness of the scene. It’s definitely about the quiet before the storm, and how people find calm and consolation by concentrating on small tasks.

There’s a selection of her paintings, below. I love the technical precision of Dunbar’s work and the dignity she gives every person in her paintings. Everyone is concentrating on the task-in-hand and doing it as best they can – keeping calm, and carrying on!

I’ve written before about the impact of the train on military thinking…the railway allowed for greater logistical reach and improved mobility. Troops and equipment could be moved about over large distances and at speed. This was crucial in the build up to battle; but it was also important for removing the injured from the front…

One of the basic principles of battlefield medicine is of triage. The military doctors evaluate the injured and sort those that can be helped, from those whose injuries are fatal. The non-fatally injured are then operated on, or moved to a more quiet area where they can be treated. In historical terms, battlefield surgery has mostly been about amputation!

The links between war and medicine are really interesting. The technical development of 20C warfare provided for the urgent development of techniques in reconstructive surgery (WW1), the treatment of severe burns (WW2), and open-heart surgery (post-WW2).

The story of WW1 reconstructive surgery is quite well known now. The widespread use of powerful artillery during WW1 produced a terrible new kind of shrapnel exit-wound. This could leave someone without half a face! At first, medical efforts were directed at simply making sure the wounds healed. That wasn’t easy. Survival and recovery produced its own trauma associated with disfigurement and isolation. Humane doctors began to consider the possibilities of reconstructive techniques and grafts. The hospital at Sidcup, Kent, was one of the main centres for this work. Sir Harold Gillies was the pioneer surgeon associated with this work.

The early efforts at this kind of surgery were documented by the artist and surgeon, Henry Tonks. Some of his work is displayed at the NPG, London, for the centenary of WW1. Tonks was a Professor at the Slade School of Art. In a previous life, he had been the assistant to the great Victorian surgeon, Sir Frederick Treves at the London Hospital. Treves is a very significant historical figure, but he is nowadays mostly associated with the story of Joseph Merrick, the Elephant Man. This story was made into a film by David Lynch (1980).

By a terrible co-incidence, there is a BBC1TV Sunday evening drama, based on WW1 nursing, called Field of Blood…

The technical development of mechanical war on land and in the air, during WW2, provided for many more injuries through the serious burns. These new types of injury were addressed through surgery and salt bath treatments at East Grinstead. The pioneer surgeon at East grinstead was Sir Archibald McIndoe.

McIndoe understood that the traumas associated with injury were both physical and psychological. At East Grinstead, he established a social club for his patients. This allowed them to begin the difficult process of post-injury social integration.

The major problems associated with battlefield amputation were blood loss and infection. New techniques to stem blood loss allowed for surgeons to attempt more complex forms of surgery. During the 1950s and 1960s rapid progress was made so that, by the end of the 1960s, a successful heart-transplant was completed. This was a direct and positive consequence of new techniques pioneered during WW2 and on military battlefields in Asia – think MASH (Mobile Army Surgical Hospital) with helicopter support.

The development of penicillin greatly reduced the threat associated with battlefield infection.

I did find a pretty good website about railway surgery, with a page about US military hospital trains…

http://railwaysurgery.org/Army.htm

The site is dedicated to railway surgery; which, in America, is a branch of surgery devoted to looking after railway employees and the specific traumas associated with work on the railroad.

Just in case anyone thinks this is all historical, here is a picture of a modern hospital train in India.

You can see Evelyn Dunbar’s work at the Imperial War Museum, London. There’s a BBC website slide show of her paintings and there’s a wiki entry. It turns out Evelyn was a neighbour of ours in East Kent. Hopefully, we’ll find one of her paintings one day.